Basic Information
| Provider Information | |||||||||
| NPI: | 1730153529 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KALDA | ||||||||
| FirstName: | ELLISON | ||||||||
| MiddleName: | F. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 SOUTH BRUCE STREET | ||||||||
| Address2: | AFFILIATED COMMUNITY MEDICAL CENTERS | ||||||||
| City: | MARSHALL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 56258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5075329631 | ||||||||
| FaxNumber: | 5075321176 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 SOUTH BRUCE STREET | ||||||||
| Address2: | AFFILIATED COMMUNITY MEDICAL CENTERS | ||||||||
| City: | MARSHALL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 56258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5075329631 | ||||||||
| FaxNumber: | 5075321176 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2006 | ||||||||
| LastUpdateDate: | 07/31/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 1227 | SD | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 7300700 | 05 | SD | MEDICAID |